Pharmacology of anxiolytic drugs

Question 1

What are the type of anxiety disorders

Answer 1

generalized anxiety disorder, Obsessive compulsive disorder,

Question 2

What is the development of anxiety

Answer 2

Pre-existing sensitivity (gene plus environment) -> learning of fear (index traumatic event) -> consolidation of fear (hours to days following event) -> expression of anxiety (memories, flashbacks, nightmares, avoidance, startle)

Question 3

What is the organ in the brain that drives a short term fear response and fear learning

Answer 3

Amygdala (site of BZD action)

Question 4

T/F: Smell and touch bypass the thalamus go straight to amygdala inducing a much stronger stress response then sound and visual stimuli

Answer 4

True

Question 5

What part of the brain causes the symptoms of fear and anxiety, symptoms

Answer 5

Locus ceruleus/ rapid hearbeat, increased blood pressure, sweating, pupil dilation

Question 6

What is the organ in the brain that drives a long term fear response

Answer 6

Bed nucleus of the stria terminalis (site of BZD)

Question 7

T/F: Memory consolidation happens in the hippocampus

Answer 7

True

Question 8

What is fear extinction, what are the relevant structures involved

Answer 8

Decrease in fear responses during repeated presentations of the conditioned stimuli without the unconditioned stimulus reinforcement/ amygdala, hippocampus and cortex

Question 9

T/F: A sedative calms a patient while a hypnotic drug produces drowsiness

Answer 9

True

Question 10

What is the real approval time frame for BZDs

Answer 10

2-4 weeks

Question 11

T/F: All BZDs have the same efficacy but there is a difference pharmcokinetics that influence the drug chosen

Answer 11

True

Question 12

T/F: BZDs can cause tolerance to sedation effects BUT NOT Anxiety effects

Answer 12

True

Question 13

What occurs when a GABA receptor is activated

Answer 13

Diffusion of chloride ions across the cell membrane

Question 14

Where does GABA bind, where does BZDs bind

Answer 14

between alpha-beta subunit, bind at the alpha-gamma interface

Question 15

T/F: BZDs are GABA agonists

Answer 15

False: BZDs are allosteric modulators that increased the affinity of GABA to the receptor

Question 16

What is a competitive BZD antagonist

Answer 16

Flumazenil

Question 17

T/F: BZDs are both allosteric modulators BUT BARBITURATES can activate Cl channel opening in the ABSENSE of GABA

Answer 17

TRUE

Question 18

T/F: Barbiturates increase the open time of GABA channels

Answer 18

True

Question 19

How come BZDs are not anesthetics

Answer 19

Patients can still feel pain

Question 20

Why do BZDs have abuse potential

Answer 20

DOPAMINE is dumped by ventral tegmental area into the Nucleus accumbens, Dopamine causes medium spiny neurons to inhibit GABA from inhibiting dopamine release to cause the cycle to continue

Question 21

What effects of BZDs causes tolerance

Answer 21

Sedation/hypnotic (greater with short half life BZDs) and Anticonvulsant/muscle relaxant

Question 22

What effects of BZDs do not cause tolerance

Answer 22

Anxiolytic, dependence potential (greater potential for dependance in short half life BZDs), amnesia

Question 23

T/F: Chronic use of BZDs is associated with dementia even after discontinuation

Answer 23

True

Question 24

What are the short acting BZDs

Answer 24

Midazolam and Triazolam

Question 25

What are the intermediate acting BZDs

Answer 25

Alprazolam, Clonazepam, Estazolam, Lorazepam, Oxazepam, Temezepam

Question 26

What are the long acting BZDs

Answer 26

Chlordiazepoxide, Clorazepate, Diazepam, Flurazepam, Quazepam

Question 27

Which BZDs can be given IM

Answer 27

Chlordiazepoxide (L), Diazepam (L), Lorazepam (I), Midazolam (S)

Question 28

What BZDs can be given IV

Answer 28

Chlordiazepoxide (L), Diazepam (L), Lorazepam (I), Midazolam (S)

Question 29

What is the only BZD that can be given rectally

Answer 29

Diazepam

Question 30

What are withdrawl effects of BZDs

Answer 30

anxiety, increased sensitivity to light and sound, muscle cramps, myclonic jerks, sleep disturbances, Seizures and delirium (high dose)

Question 31

T/F: Drug accumulation is most likely to happen in BZDs that are long acting

Answer 31

True

Question 32

What is the anti-anxiety MOA of busprione, anti depressant property

Answer 32

Full agonist at the pre-synaptic 5-HT1 receptors inhibiting 5-HT synthesis and firing, partial agonist at post synaptic 5-HT1A

Question 33

What are the benefits of buspirone over BZDs

Answer 33

Nonwithdrawl syndrome, no tolerance to anxiolytics effects

Question 34

T/F: Just like BZDs there is no evidence of tolerance to anxiolytic effects when using buspirione

Answer 34

True

Question 35

Which hypertensive drug decreases norephinephrine therefore decreasing the anxiety response

Answer 35

Clonidine